A Proposal for a Classification for Recurrent Endometrial Cancer: Analysis of a French Multicenter Database From the FRANCOGYN Study Group

Alexandre Bricou (1) , Sofiane Bendifallah (2) , Mathilde Daix-Moreux (1) , Lobna Ouldamer (3) , Vincent Lavoué (4) , Amélie Benbara (5) , Cyrille Huchon (6) , Geoffroy Canlorbe (2) , Emilie Raimond (7) , Charles Coutant (8) , Olivier Graesslin (7) , Pierre Collinet (9) , Xavier Carcopino (10, 11) , Cyril Touboul (12) , Emile Daraï (2) , Lionel Carbillon (1) , Marcos Ballester (2)

1 Service de gynécologie-obstétrique [Hôpital Jean Verdier]
2 CHU Tenon [AP-HP]
3 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
4 Service de Gynécologie et Obstétrique [Rennes] = Gynaecology [Rennes]
5 CHU Saint-Antoine [AP-HP]
6 Service de gynécologie et obstétrique [CHI Poissy-Saint Germain]
7 Hôpital universitaire Robert Debré [Reims]
8 UNICANCER/CRLCC-CGFL - Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon]
9 Service d'obstétrique-gynécologie [Lille]
10 IMBE - Institut méditerranéen de biodiversité et d'écologie marine et continentale
11 Service de gynécologie-obstétrique [Hôpital Nord - APHM]
12 Service de gynécologie et obstétrique [Créteil]

Objective: Endometrial cancer (EC) recurrences are relatively commonwith no standardized way of describing them.We propose a new classification for them called locoregional, nodal,metastasis, carcinomatosis recurrences (rLMNC). Patients and Methods: The data of 1230 women with EC who were initially treated by primary surgery were included in this French multicenter retrospective study. Recurrences were classified based on dissemination pathways: (1) locoregional recurrence (rL); (2) nodal recurrence (rN) for lymphatic pathway; (3) distant organ recurrence (rM) for hematogenous pathway; and (4) carcinomatosis recurrence (rC) for peritoneal pathway. These pathways were further divided into subgroups. We compared recurrence free survival and overall survival (OS) between the 4 groups (rL/rN/rM/rC). Results: The median follow-up was 35.6 months (range, 1.70Y167.60). One hundred ninety-eight women (18.2%) experienced a recurrence: 150 (75.8%) experienced a singlepathway recurrence and 48 (24.2%) a multiple-pathway recurrence. The 5-year OSwas 34.1% (95% confidence interval [CI], 27.02%Y43.1%), and the median time to first recurrence was 18.9 months (range, 0Y152 months). The median survival after recurrence was 14.8 months (95% CI, 11.7Y18.8). Amongwomenwith single pathway of recurrence, a difference in 5-year OS(PG 0.001) and survival after recurrence (P G 0.01)was found between the 4rLNMCgroups. The carcinomatosis group had the worst prognosis compared with other single recurrence pathways.Women with multiple recurrences had poorer 5-yearOS (P G 0.001) and survival after recurrence (P G 0.01) than those with single metastasis recurrence, other than women with peritoneal carcinomatosis. Conclusions: This easy-to-use and intuitive classification may be helpful to define EC recurrence risk groups and develop guidelines for the management of recurrence. Its prognosis value could also be a tool to select homogenous populations for further trials.

Mots clés: Endometrial cancer; Recurrences; Relapses; Classification

Domaines: Santé; Gynécologie et obstétrique; Cancer

Alexandre Bricou, Sofiane Bendifallah, Mathilde Daix-Moreux, Lobna Ouldamer, Vincent Lavoué, et al.. A Proposal for a Classification for Recurrent Endometrial Cancer: Analysis of a French Multicenter Database From the FRANCOGYN Study Group. International Journal of Gynecological Cancer, 2018, 28 (7), pp.1278-1284. ⟨10.1097/IGC.0000000000001296⟩. ⟨hal-02111165⟩